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    Preventive Care in Inflammatory Bowel Disease (beta)

    Official guideline from the American College of Gastroenterology.

    Strength
    Strong recommendation
    Conditional recommendation
    Evidence
    Low quality evidence
    Very low quality evidence

    Vaccination

    Vaccination
    1. All adult patients with IBD should undergo annual vaccination against influenza.
    2. Those on immunosuppressive therapies and their household contacts should receive the non-live trivalent inactivated influenza vaccine, but not the live inhaled influenza vaccine.
    3. Adult patients with IBD receiving immunosuppressive therapy should receive pneumococcal vaccination with both the PCV13 and PPSV23, in accordance with national guidelines.
    4. Adults with IBD over the age of 50 should consider vaccination against herpes zoster, including certain subgroups of immunosuppressed patients.
    5. Adults with IBD should be assessed for prior exposure to varicella and vaccinated if naive before initiation of immunosuppressive therapy when possible.
    6. Patients with IBD who are immunosuppressed and traveling to endemic areas for yellow fever should consult with a travel medicine or infectious disease specialist prior to travel.
    7. Adolescents with IBD should receive meningococcal vaccination in accordance with routine vaccination recommendations.
    8. Household members of immunosuppressed patients can receive live vaccines with certain precautions.
    9. Adults with IBD should receive age-appropriate vaccinations before initiation of immune suppression when possible.
    10. Vaccination against Tdap, HAV, HBV, and HPV should be administered as per Advisory Committee on Immunization Practice guidelines.

    Screening

    Screening
    1. Women with IBD on immunosuppressive therapy should undergo annual cervical cancer screening.
    2. Screening for depression and anxiety is recommended in patients with IBD.
    3. Patients with IBD (both ulcerative colitis and CD) should undergo screening for melanoma independent of the use of biologic therapy.
    4. IBD patients on immunomodulators (6-mercaptopurine or azathioprine) should undergo screening for NMSC while using these agents, particularly over the age of 50.
    5. Patients with conventional risk factors for abnormal bone mineral density with ulcerative colitis and CD should undergo screening for osteoporosis with bone mineral density testing at the time of diagnosis and periodically after diagnosis.

    Smoking

    Smoking
    1. Patients with CD who smoke should be counseled to quit.
    What do the icons mean?  
    Research PaperFarraye FA, Melmed GY, Lichtenstein GR, Kane SV. Acg clinical guideline: preventive care in inflammatory bowel disease. American Journal of Gastroenterology. 2017;112(2):241-258.